Authorization Representative, Lourdes Imaging Center

Job Description

What Makes Us Different?

At FMOLHS, we offer you so much more than just a job in the healthcare industry. We offer career opportunities for people who have a calling to share their gifts and talents as part of our healing ministry. As a Catholic hospital, we are here to create a spirit of healing. We offer you something special - the chance to do God's work by helping to serve people in need throughout our community, every day.

Job Summary

The Authorization Rep ensures patients have been cleared for Hospital services, specialty service and office visits. Resolves pre-certification, registration and case-related concerns and determination of patient financial obligation prior to a patient's service or visit. Works with insurance carriers, financial counselors, specialists and other ancillary staff. Also responsible for accurately validating patient information and ensuring the patient's experience is best in class. Relies on guidelines to accomplish tasks. Relies on experience and judgment to complete job. Works under general supervision.

Minimum Requirements

Experience: 1 year experience in medical office or hospital setting

Education: High School or equivalent

Special Skills: Basic clerical and computer skills

Apply now! Here, you are more than an employee. You are a team member, a co-worker, our friend and part of our family. Our healthcare team is working together to heal this community one patient at a time!

Responsibilities

• Customer Service
• Gathers information from the chart and clinic personnel regarding insurance coverage and reason for the procedure.
• Gathers information from the chart and clinic personnel regarding insurance coverage and reason for the procedure.
• Relays authorization approval, peer to peer request or denial status to the clinic personnel and physician timely to facilitate patient care.
• Accurately and efficiently processes referrals to specialists, hospitals and diagnostic centers in accordance with physician orders processing referrals in a timely manner for required services in the most appropriate setting; coordinates the referrals with insurance providers so that financial liability to the patient is minimized.
• Obtains/scans outside clinic records after patient appointment with specialist to assure continuity of care.
• Quality
• Utilizes available resources to determine if physician is participating with patients' insurance plan. Ensures lists of doctors and needed items are updated and modified as necessary.
• Attends meetings as required and participates on committees as directed. Strives to improve the quality of meeting by taking an active role in meeting topics.
• Assures that authorizations are obtained prior to date of service for 99 % of cases scheduled.
• Schedules are reviewed prior to date of service to assure that authorization numbers have been obtained for all procedures that require one.
• Scans authorization confirmation/denials into chart in a timely manner to facilitate claims processing should issues arise.
• Financial
• Responsible for the verification of insurance information, as well as documenting the need for authorization or lack of need for authorization in the computer system to facilitate claims processing.
• Contacts insurance carriers to secure authorization information. Documents authorization information in the computer system to ensure visits are approved.
• Acts as a resource for the department personnel as it relates to the authorization process and documentation required for services.
• Other Duties as Assigned
• Performs other duties as assigned or requested.
  
  

Qualifications

Experience: 1 year experience in medical office or hospital setting

Education: High School or equivalent

Special Skills: Basic clerical and computer skills